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Malignant mesenchymal tumors of the female genital tract are uncommon gynecological cancers, particularly in the vagina. They are typically aggressive and often relapse, both locally and at distant sites. The treatment of choice for primary tumors is surgical excision as they are generally refractory to chemotherapy and radiotherapy. We describe the case of a vaginal leiomyosarcoma in a 43-year-old woman who presented with abnormal genital bleeding and discharge. The tumor was excised but recurred locally after just 11 months. It was removed by hysterectomy with double adnexectomy and partial vaginal excision.

Cribriform-morular variant of papillary thyroid carcinoma (CMV-TC) shows a peculiar mixture of follicular, cribriform, papillary, trabecular, and solid patterns with squamoid morules. Ocassionally, lung metastasis may be interpreted incorrectly as primary lung adenocarcinoma. We illustrate a case of pulmonary meastasis of CMV-TC mimicking a primary adenocarcinoma, 7 years after diagnosis of CMV-TC. The lung metastases may be easily missed if the pathologist is unaware of the patient's prior history and a limited immunohistochemical panel (CK7 and TTF-1) is used. The histologic and immunohistochemical (β-catenin+, ER+, PR+, TTF-1 +, and CK7+) findings were diagnostic of CMV-TC and ensured adequate treatment.

Highlights • This entity has pathological characteristics identical to mucinous colorectal carcinoma. • KRAS mutations are observed in approximately 40% of colorectal cancers. • The treatment and management may not differ from that of squamous cell carcinomas., Purpose To report a case of intestinal-type adenocarcinoma of the Bartholin gland treated successfully with surgery and to review the current literature. Methods We report the case of a 45-year-old white woman with intestinal-type adenocarcinoma of the Bartholin gland treated with wide local excision followed by bilateral inguinal femoral lymph node dissection without adjuvant therapy. We also review the literature on the treatment and management of this rare tumor. We searched Pubmed / MEDLINE databases for previous case reports or series using the keywords “Bartholin gland”, “adenocarcinoma” and “intestinal type”. Results We found 19 cases of intestinal-type adenocarcinoma of the Bartholin gland published up to November 2020. The treatments described varied from case to case. Conclusion Intestinal-type adenocarcinoma of the Bartholin gland has been treated and managed in the same way as squamous carcinoma. Treatment of these cancers is understudied and involves local resection with curative intent. More case reports are needed to determine the best treatment strategies.

BackgroundThe spread of cervical squamous cell carcinoma to the inner surface of the uterus with replacement of the endometrium is rare. Continuity of the lesion must be demonstrated to confirm superficial spread and rule out concomitant endometrial cancer.Case presentationWe present the case of a 66-year-old white woman with superficial spreading squamous cell carcinoma of the cervix that involved the endometrium. Her relevant past history included conization of the cervix to treat cervical intraepithelial neoplasia III with positive margins. She subsequently had three negative cervical vaginal cytology results, each with a positive high-risk human papillomavirus test. Transvaginal ultrasound showed occupation of the entire uterine cavity by dense material consistent with pyometra in addition to myometrial thinning due to tension and cervical dilation. The patient presented with greenish vaginal discharge of 3 months’ duration. The cervix was not visible during speculum examination. Access for endometrial sampling was not possible, raising suspicion of post-conization cervical stenosis. The patient was treated with laparoscopic hysterectomy with double adnexectomy. Histologic examination showed superficial squamous cell carcinoma invading the cervix to a depth of 2.8 mm; superficial spreading squamous cell carcinomain situwas also observed in the lower uterine segment and endometrium. The patient was free of symptoms 12 months after surgery.ConclusionsSquamous cell carcinoma of the cervix with superficial spread to the endometrium is not included in the 2020 (fifth edition) World Health Organization Classification of Female Genital Tract Tumors or the 2018 International Federation of Gynecology and Obstetrics cervical cancer staging system. More clinical cases are needed to identify other prognostic factors and inform clinical practice guidelines on the management of this disease.

Background Medullary thyroid carcinoma very rarely metastasizes to the breast. Hematogenous spread to the liver, lungs, or mediastinum is more common. Case We describe the morphologic and immunohistochemical features of a 63‐year‐old woman who presented with a BIRADS‐5 category nodule in the right breast and enlarged axillary lymph nodes. Core biopsy showed suggested breast cancer with neuroendocrine or apocrine differentiation. The immunohistochemical profile showed (RE−/RP−/HER‐2−) and Ki67 10%. Chromogranin and synaptophysin were positive; AR and GCDFP‐15 were negative. On reviewing the patient's clinical history, it was discovered that she had been treated for medullary thyroid carcinoma 15 years earlier. Additional stains showed positivity for TTF‐1, CEA, and calcitonin. These findings were consistent with a diagnosis of breast metastasis from medullary thyroid carcinoma. We discuss briefly the morphologic features and the possible key features in order to make an accurate diagnosis. Conclusion This case highlights the importance of investigating a history of cancer in patients with discordant or unusual histologic or immunohistochemical findings, as this can help avoid misdiagnosis and inappropriate treatment.

Resumen Describimos 2 pacientes con sintomas de colitis microscopica, cuyo estudio histopatologico mostro colitis colagena con imagenes atipicas. Un caso (varon de 54 anos) presento diarrea tras la administracion de acarbosa por diabetes tipo 2, que remitio al eliminar su medicacion en 2 ocasiones. Las biopsias de colon mostraron colitis colagena con presencia de celulas gigantes multinucleadas en la porcion superficial de la mucosa. Otro caso (mujer de 60 anos) presento diarrea acuosa de 3 anos de evolucion. Se descarto etiologia infecciosa y autoinmune. La colonoscopia fue normal. Las biopsias colonicas mostraron colitis colagena con seudomembranas. Discutimos brevemente la posible etiologia de estas 2 variantes atipicas de colitis microscopica. En resumen, presentamos 2 casos atipicos de colitis microscopica: uno de colitis colagena con celulas gigantes inducido por acarbosa, y otro de colitis colagena con seudomembranas.

Resumen El tumor de celulas granulares de la mama es una neoplasia infrecuente y generalmente benigna derivada de las celulas de Schwann. Presentamos el caso de una mujer con tumor de celulas granulares de la mama, asi como una revision de los casos descritos en la literatura medica espanola durante los ultimos 20 anos. Debido a que clinica y radiologicamente pueden presentarse de forma muy diversa, y simular un carcinoma de mama, el tumor de celulas granulares debe incluirse en el diagnostico diferencial de los tumores de la mama por las implicaciones terapeuticas que conlleva.

Resumen Describimos el caso de un schwannoma gastrico en un paciente de 64 anos que clinica y radiologicamente simulaba un tumor del estroma gastrointestinal. Se realizo una gastrectomia parcial y se encontro un tumor de 4 cm de diametro en la pared muscular, con mucosa integra. Microscopicamente, presento un patron de crecimiento fusocelular con notable presencia de acumulos linfoides en la periferia e intralesionales. Se observaron escasas formaciones similares a cuerpos de Verocay abortivas. Ademas, se observaron celulas gigantes multinucleadas tipo osteoclastico dispersas aleatoriamente. Las celulas fusiformes mostraron atipia leve focal. No se identificaron figuras de mitosis. Inmunohistoquimicamente, las celulas fusiformes se tineron intensa y difusamente con S-100 y GFAP, mientras que las tinciones de CD34, CD117 y DOG1 fueron negativas. Las celulas multinucleadas fueron CD68 positivas. Describimos brevemente su diagnostico diferencial.

We report a case of lymphoepithelioma-like carcinoma of the urinary bladder in an elderly female patient. A 97-year old woman presented with hematuria, and an ultrasonographic urinary study showed a localized tumor in the trigone region of the urinary bladder. A transurethral resection revealed a mixed tumor formed by high-grade transitional carcinoma and lymphoepithelioma-like carcinoma that had infiltrated into the muscular propria. We describe the clinicopathological, morphological and immunohistochemical features of this tumor and briefly discuss its differential diagnosis and biological behavior.

We report a case of a 70-year old woman with a high-grade myxofibrosarcoma which presented as a subcutaneous tumor in the posterior right thigh. Fine-needle aspiration revealed isolated and three-dimensional groups of spindle cells with high-grade atypia and a myxoid background. The cytoarchitecture of the tumor showed non-distinctive, highly cellular spindle cell morphology, whilst other areas had a very prominent myxoid matrix with elongated, curvilinear blood vessels. A few scattered mucin-containing pseudolipoblasts were also observed. The differential diagnosis with other myxoid lesions is discussed; a correct diagnosis is important as the metastatic risk is lower than most types of adult high-grade pleomorphic sarcoma.

We report the cytohistologic and immunohistochemical findings of an oncocytic variant of poorly differentiated thyroid carcinoma in a 76-year old man with a prior history of prostatic adenocarcinoma. The man complained of a palpable nodule in the right thyroid lobe and cervical lymph node. Fine-needle aspiration (FNA) in both cases yielded solid clusters of cells/insulae, microfollicles, and isolated atypical cells. Considering the patient's past history, an initial diagnosis of metastasis from prostate adenocarcinoma was considered. However, immunohistochemical staining of liquid-based cytology specimens (Thin-Prep) showed diffuse positive results for TTF-1 and thyroglobulin. The patient underwent total thyroidectomy with bilateral neck dissection. Histologic and immunohistochemical evaluation showed a poorly differentiated oncocytic thyroid carcinoma with lymphovascular invasion and lymph node metastases. To our knowledge, this is the first description of the immunocytochemical evaluation of this rare variant of poorly differentiated thyroid carcinoma using FNA and liquid based cytology.

Uterine leiomyosarcoma (LMS) with osteoclastic giant cells (OGCs) is extremely rare. However, its morphological appearance and aggressive behavior may have resulted in its being diagnosed as so-called giant cell malignant fibrous histiocytoma (MFH) in the past. Effusions are not uncommon in LMS and may be indicative of an unfavorable prognosis. We report a case with the cytological appearance of a uterine LMS with OGCs metastatic to lower pelvic peritoneum. The pelvic washing specimen consisted of three-dimensional aggregates of atypical cells. The cytohistologic and immunohistochemical study obtained from the cell block and the tumor mass showed overlapping features such as bizarre pleomorphic spindle cells containing numerous evenly dispersed OGCs. The malignant tumor cells showed extensive positivity for desmin, h-caldesmon and multifocal positivity for smooth muscle actin (SMA) whereas OGCs stained with CD68. We stress the usefulness of performing cell block and subsequent immunohistochemistry in order to make an accurate cytohistologic correlation.

We report a case of medullary thyroid carcinoma (MTC), spindle cell variant, which exhibited striking histological pseudovascular clefts and abortive lumina, closely mimicking an angiosarcoma. The patient is a 72-yr-old-man who presented facial rash and a solid nodule in the right lobe of the thyroid gland. The fine-needle aspiration (FNA) showed bloody background containing loosely groups of fusiform and plasmocytoid cells with coarse chromatin and eosinophilic granular cytoplasms. Microscopically, the tumor exhibited spindle-cell pattern intermingled with a striking angiosarcoma-like pattern characterized by the presence of abortive lumen and clefts containing erythrocytes. Dense hyaline extracellular amyloid was present. The tumor cells were strongly positive for cytokeratin, chromogranine-A, synaptophysine, serotonin, calcitonin, and CEA. TTF-1 was weakly positive. Stains for CD34 and CD31 were negative. This case illustrates that the spindle cell variant of MTC may exhibit an infrequent angiosarcoma-like appearance which may be misdiagnosed as angiosarcoma.

The clinical and histological findings of four cases of renal mucinous tubular and spindle cell carcinoma (MTSCC) are reported. Two cases were incidentally discovered during the radiological study of other diseases, and the other two presented with haematuria. Radical nephrectomy was done in the four cases. All the tumours showed the typical histology and immunohistochemistry described in this newly recognised entity. The patients remain free of disease after 3, 8, 10 and 48 months of follow up. The literature related to the diagnosis of this tumour is thor oughly reviewed. Also, the proposed histopathogenetic theories for this tumour are also briefly commented on. The new 2004 WHO classification system of renal tumours is based on morphologic criteria and supported by common genetic findings. 12 Among other rare entities, it includes a variant of renal carcinoma termed mucinous tubular and spindle cell carcinoma (MTSCC). This tumour type had been previously diagnosed as papillary renal carcinoma, metanephric adenoma, unclassified or sarcomatoid carcinoma, 5,8,11,13 and seems to portend a favourable clinical outcome. We report the clinicopathological findings of four additional cases of this rare newly recognised tumour, highlighting its varied histological patterns and differential diagnosis. The cases were col lected retrospectively from consultation of our archive in the last 3 years.

We describe for the first time the cytologic features of mucinous spherulosis (MS), a variant of collagenous spherulosis (CS) of the breast characterized by cribiform structures containing lightly basophilic material, embedded in a loosely mucinous acellular background. Histologically, the lesion was part of a complex hyperplasia containing foci of sclerosing adenosis, and foci of atypical ductal hyperplasia (ADH). Immunohistochemical study showed reactivity with smooth muscle actin and focally for cytokeratin 14. Cytologic features of MS were recognized retrospectively and consisted of intermediate to large round hyaline spherules, naked or surrounded by myoepithelial cells. A fibrillary radial appearance was observed with Diff-Quick stain. We draw attention to the importance of recognizing these features because they can easily pose problems either by being overlooked or overdiagnosed as mucinous carcinoma. Differential diagnosis is briefly discussed.

BACKGROUND Gastrointestinal stromal tumors (GISTs) may exhibit a fusiform, epithelioid or mixed pattern of growth. Only rare articles report the cytologic and immunohistochemical features of malignant epithelioid tumors. CASE A 57-year-old woman presented with a tumor mass in the small intestine omentum measuring 8 x 7 cm; it was surgically removed. Five years later 2 mesenteric relapses were studied by fine needle aspiration biopsy and later surgically excised. Cytologically the smears contained small clusters of epithelioid and plasmacytoid cells with round nuclei. The presence of nucleoli and occasional nuclear grooves were prominent. Focally the background was myxoid. Histologically the tumor showed an epithelioid pattern with moderate pleomorphism and mitoses in 6 of 50 high-power fields. Immunohistochemical study showed positivity for c-kit (CD117), vimentin, smooth muscle actin and caldesmon, and focally for desmin and cytokeratin. CONCLUSION This case illustrates the difficulty in making a reliable diagnosis of the epithelioid variant of GIST by cytology alone. The immunohistochemical panel (apart from c-kit) should include smooth muscle markers and cytokeratins because they are more likely to be reactive. A complete cytoimmunohistochemical evaluation is mandatory to make an accurate diagnosis.

The diagnosis of cellular schwannoma in intraoperative consultation is difficult because of the hypercellularity and deep location, which may lead to errors. The recognition of cytologic features together with the histological appearance are of great importance to make the correct diagnosis. An accurate diagnosis of this variant of schwannoma is important because other spindle cell tumors display differences in treatment and clinical behavior. We report a demonstrative case of cellular schwannoma arising in retroperitoneum of a 52-yr-old woman in which the cytologic imprints were useful to make an accurate diagnosis intraoperatively. Briefly, the differential diagnosis is discussed.

We describe the cytological features of a soft-tissue high-grade spindle and pleomorphic sarcoma. The smears showed hypercellularity composed of pleomorphic round and elongated cells, and a striking population of multinucleated osteoclast-type giant cells. Microscopically the tumor showed multiple patterns such as highly cellular pleomorphic, less cellular, and hyalinized areas with neoplastic cartilage and osteoid, and areas with hemorrhage and multicystic appearance with numerous osteoclastic giant cells, resembling aneurysmal bone cysts. Immunohistochemical studies showed positivity for vimentin, while chondroid tissue was positive for S-100, and osteoclastic giant cells stained positively for CD68. Due to the varied microscopic patterns, the differential diagnosis included many tumors containing osteoclastic giant cells and osteochondroid tissue.

The quantitation of microvessels in breast cancer in sections immunolabeled for factor VIII, CD-34, or CD-31 currently is expressed as numbers of vessels/mm2. In an attempt to perform a more accurate method for counting microvessels, we determined the number of microvessels by 1,000 tumor cells (angiogenic index; AI). This new method minimizes the possible variations concerning the width of the microscopic fields, stroma/epithelium relations, and cellular tumor size. The present study compares the number of vessels determined by the traditional method (vessels/mm2) and AI in a series of 215 cases of ductal infiltrating carcinoma not otherwise specified. Also we studied the degree of correlation between both methods and with pathologic variables (tumor size, histologic grade, mitotic count, tumor necrosis, vascular invasion, skin infiltration, and axillary lymph node metastasis). Our results showed that the AI correlates more significantly than the classic microvessel density determination with other prognostic factors in breast cancer. In histologic grade III tumors, high AI correlates significantly with the presence of more than three axillary lymph nodes metastases. Therefore we recommend determining the degree of tumor angiogenesis by counting vessels per 1,000 tumor cells (AI) because of its reliable determination and significant correlation with other prognostic factors.

Adrenal cortical carcinoma (ACC) is a rare neoplasm that affects all age groups, with a bimodal peak of incidence, in young individuals in the first decade or two of life and in older subjects in the fifth to seventh decades. It may be clinically “functional” with Cushing's syndrome, virilization, or feminization, or it may be “nonfunctional.” We report on the case of a 42-yr-old woman who complained of abdominal pain and a large adrenal tumor measuring 20 cm in size. No endocrine symptoms were observed. Laboratory tests showed increased levels of adrenocorticotropic hormone (ACTH), serum cortisol, and urinary free cortisol. Cytohistologic features were typical of ACC. A striking presence of hyaline cytoplasmatic globules was seen in cytologic smears and histologically, being immunoreactive for vimentin, consistent with an intracellular store of intermediate filaments. The tumor showed high proliferative activity (40%) with Ki-67 and negativity for p53, cerbB2, and bcl-2. Although hyaline globules are more frequent in pheochromocytomas and other neoplasms, they may also be present in ACC. These globules may be observed in cytologic smears. Also, the identification and immunohistochemical characterization of these hyaline globules in metastases may be useful in determining the origin of primary occult tumors. Diagn. Cytopathol. 1999;21:394–397. © 1999 Wiley-Liss, Inc.

A 50-yr-old man presented with dyspnea. On chest X-ray, multiple pulmonary nodules were observed. Fine-needle aspiration biopsy (FNAB) showed tridimensional aggregates of atypical round epithelial cells, containing numerous cytoplasmic granules. The tissue fragment confirmed the presence of an epithelial tumor composed of trabecular sheets of clear cells, with numerous cytoplasmic granules which stained with phosphotungstic acid hematoxylin (PTAH). Immunohistochemically, the tumor cells were positive for cytokeratins and antimitochondrial antigen, whereas chromogranin, synaptophysin, S-100 protein, and HMB-45 were negative. Clinical and tomographic studies ruled out any tumor mass elsewhere. The rarity of this lesion in the lung and the potential difficulties for its diagnosis prompted us to report the clinical, cytological, and immunohistochemical findings in this case.

Background Giant cell carcinoma (GCC) of the lung is an unusual tumor characterized by an aggressive outcome. Case A peripheral lung tumor was observed in an elderly male. At presentation the clinical symptoms were cough, thoracic pain and hemoptysis. Chest roentgenography showed a left pleural effusion and neutrophilia in the blood. Bronchoscopic examination showed a peripheral tumor mass that could not be biopsied. Bronchoalveolar lavage was negative. The patient underwent a cerebrovascular accident and died. The autopsy showed a peripheral giant cell tumor of the left lung that involved regional and mediastinal lymph nodes. Touch imprints showed tridimensional clusters of pleomorphic and large cells, some of which were multinucleated, containing leukocytes in their cytoplasm. Conclusion This case illustrates the typical cytohistologic features of GCT of the lung, which should be considered in the differential diagnosis of any peripheral lung tumor composed of large cells. Clinical correlation is helpful in reaching the correct diagnosis.

Adenomyoepithelioma is a rare breast tumor. Histologically it may disclose different patterns of growth, and some additional features may result in diagnostic errors. We describe 2 cases of adenomyo- epithelioma of the breast initially examined by fine-needle aspira- tion biopsy (FNAB). Cytologic features included hypercellularity, clusters of epithelial and myoepithelial cells with occasional intranuclear inclusions, prominent apocrine metaplasia, and foam cells. Histologically, both tumors were diagnosed as adenomyoepi- thelioma tubular-variant, with prominent myoepithelial clear cells, apocrine metaplasia, and foci of squamous metaplasia. Immunohis- tochemically, the tumors showed strong positivity for keratins CAM 5.2, AE1/AE3, and EMA in the epithelial component, while the myoepithelial cells reacted with muscle-specific actin (A14 and HHF35) and S-100 protein. We point out that FNAB in this rare tumor may exhibit a varied spectrum of cells that may result in confusion with other lesions, and we call attention to the presence of intranuclear inclusions. The latter observation in the present cases by cytologic and histologic assessment provides an addi- tional feature to the morphological characteristics of adenomyo- epithelioma of the breast. Diagn. Cytopathol. 1998;19:55-58. r 1998 Wiley-Liss, Inc.

BACKGROUND: Endocrine differentiation in breast cancer in females is uncommon and well established, while only rare articles reported the cytologic features. CASE: Invasive ductal carcinoma of the breast with endocrine features occurred in an 83-year-old female. The aspirates were hypercellular, containing many cohesive aggregates of uniform, round cells with central nuclei and granular cytoplasm intermixed with fine capillary vessels. The subsequent mastectomy specimen contained a well-delimitated tumor mass measuring 2.5 cm in diameter. Microscopically the tumor was formed by a typical solid and organoid pattern of growth. Immunohistochemical study showed positivity for estrogen and progesterone receptors, cytokeratins and chromogranin. None of 10 axillary lymph nodes contained metastasis. The patient was well seven months after surgery. The cytologic features encompassed signs of endocrine differentiation. CONCLUSION: This case illustrates the clinicopathologic features of a ductal infiltrating carcinoma with endocrine features and renders the clues to cytologic diagnosis with accuracy on fine needle aspiration.

Summary To evaluate four methods to study cellular proliferation (mitotic count, mitotic index, PCNA and MIB 1) in a series of breast ductal invasive cancer NOS, and the possible correlations between these different methods and other pathological variables, we studied 110 ductal invasive carcinomas NOS specimensMitoses per 1000 tumor cells and per 10 HPF, and immunostaining for PCNA and MIB 1 were evaluatedOther accepted prognostic factors such as tumor size, histologic grade, estrogen and progesterone receptors measured by immunostaining and axillary status were obtainedCorrelation between the four methods to evaluate cellular proliferation and these other variables was performedMitotic count, mitotic index, PCNA and MIB 1 showed a good rate of correlation (r = 0.71-0.53, p

The clinicopathologic features of a giant adrenal myelolipoma (diameter 16 cm, weight 900 g) are presented. The ultrasonographic and the computed tomographic appearance of adrenal myelolipoma are reviewed. Diagnostic fine-needle aspiration biopsy is recommended for avoidance of unnecessary surgical treatment.

The presence of myofibroblasts in the stroma of Phyllodes tumor of the breast has been documented in single cases by means of electron microscopy and immunohistochemistry. In this study, we re-evaluate the immunophenotype exhibited by 28 Phyllodes tumors (14 benign, 6 borderline and 8 malignant) in order to state the relevance of myofibroblasts as active stromal elements in these tumors. Vimentin showed positive immunostaining in the stroma of all the cases (100%), muscle-specific actin in 21 (75%), and desmin in 7 (25%). By contrast, stromal cells were uniformly negative for S-100 protein, keratins (AE1/AE3 and CAM 5.2), and epithelial membrane antigen (EMA). The epithelial component showed the typical two-layered arrangement of ducts in every case. Myoepithelial (outer) cells immunostained with muscle-specific actin and S-100 protein, and in some cases with EMA and keratins, whereas the epithelial (inner) layer did so with keratins and EMA. To conclude, we have found a prominent myofibroblastic differentiation in stromal cells of many of such tumors. Our results also prove that no differences in intensity or distribution of such actin-positive stromal cells are seen between benign, borderline or malignant counterparts.

Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive neoplasm. We investigated the potential utility of touch imprints evaluated in conjunction with the histology of lymph nodes in the diagnosis of AITL. CASE A 58-year-old man presented with generalized lymphadenopathy, splenomegaly, and autoimmune phenomena, which complicated the diagnosis. Touch imprints were obtained from the lymph node biopsy, which were valuable in making the correct diagnosis. The cytologic and microscopic features of these imprints and lymph node samples showed a heterogeneous population of hematolymphoid cells, including small to intermediate lymphoid cells, immunoblasts, plasma cells, dendritic cells, and eosinophils, as well as small vessels that were surrounded by some of the abnormal cells. Neoplastic cells stained positive for CD3, CD4, and CD5. Isolated immunoblasts stained with CD20 and CD30.We draw attention to this neoplastic diagnosis and correlate the cytomorphologic and immunohistochemical findings with the adequate clinical setting in order to avoid misdiagnosis, primarily with Hodgkin's lymphoma and reactive hyperplasia. Touch imprints are useful in the diagnosis of AITL if the broad population of proliferating cells is distinguished. However, some cases display binucleated or mononucleated cells with prominent nucleoli and many eosinophils, which may induce a potential misdiagnosis with Hodgkin's lymphoma.

Paragangliomas are neural crest-derived neuroendocrine tumors. Nearly 5 to 10% occur in extraadrenal sites, from the upper cervical region to the pelvis, related to the autonomic nervous system. Very few cases of gastric or paragastric paragangliomas have been reported. We report a paraganglioma attached to the stomach of an 85-year-old man. The tumor was 15 cm in diameter and was surgically resected via a subtotal gastrectomy. Fine-needle aspiration smears showed round epithelioid cells forming acini and spindle cells attached to capillaries. Occasional cells showed excentric nuclei and pale vesicular cytoplasm. Microscopically, the tumor was characterized by an alveolar and solid pattern of growth with some unusual features, such as myxoid stroma and pseudoalveoli that contained myxoid material. Spindle cells stained with vimentin and S-100 protein, whereas epithelioid cells showed diffuse cytoplasmic staining with chromogranin A. Electron microscopy of the tumor tissue revealed the presence of neurosecretory granules. To the best of our knowledge, this pattern of growth has yet to be described in the literature and may result in a misdiagnosis if sufficient immunohistochemical markers are not employed. We briefly discuss the cytomorphological features and differential diagnosis of this tumor, which was discovered in a rare location. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.

Adrenal vascular cysts are rare lesions that might be considered in the differential diagnosis of adrenal tumors. Their origin is not clear. We report the clinicopathological findings of a large adrenal hemorrhagic pseudocyst (AHP) in a 73-yr-old man who complained of abdominal pain. An abdominal CT showed a 9 cm tumor in the left adrenal. A fine-needle aspiration biopsy (FNAB) was hemorrhagic and inconclusive. The tumor was excised and touch imprints were taken showing groups of spindled and fusiform cells with elongated nuclei, without atypia. Histologically, the tumor was well delimited by a fibrous capsule and contained numerous cystic spaces lined by endothelial cells and filled with erythrocytes, fibrin thrombus, and necrotic debris. Immunohistochemical study showed strong positivity for factor VIII-RA, CD31, and CD34. Also, the remaining adrenal showed a prominent frame of thin and medium caliber vessels, supporting a vascular origin for this entity. This case illustrates the difficulty in making a diagnosis by FNA and to keep in mind AHP when hematic aspirates are obtained from an adrenal tumor mass.

Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue tumor arising in extremities. We report a typical case of EMC in left inguinal region of a 71-year-old man, which was first approached by fine-needle aspiration, followed by surgical excision and subsequently diagnosed by microscopic examination and immunohistochemical study. We discuss briefly the differential diagnosis. It is important to separate EMC from other myxoid soft tissue tumors. We point out that although cytologic features may be orientating to a myxoid tumor, may not be completely distinctive.

Nodular fasciitis (NF) is a tumor-like condition composed of fibroblasts and myofibroblasts, usually located in the subcutaneous tissue of the extremities. Histologically, it can mimic a myogenic sarcoma because of its hypercellularity, brisk mitotic rate and the presence of actin. NF of the vulva is rare with only eleven cases reported in the English literature. A 40 year-old woman developed a nodule in labium majus that was surgically excised. Microscopical examination revealed a typical example of NF with occasional multinucleated giant cells. The immunohistochemical study showed positivity for vimentin and muscle-specific actin in the spindle cells. The multinucleated cells stained with CD68. MIB-1 was positive in less than 5% of the cells which indicated a low proliferative activity. The patient has been followed for 5 years and no relapses occurred. The rarity of this lesion in the vulva and the potential difficulties for its diagnosis led us to report the clinical and immunohistochemical study of this case.

We report a salivary duct carcinoma (SDC) of parotid gland in a 75-year-old male. Initially, it was studied by fine-needle aspiration, which disclosed features of malignancy consistent with a high-grade carcinoma. Histologically, the tumor showed typical features of SDC, predominantly with a solid and apocrine pattern. The aggressive behavior of this tumor was documented by facial palsy and the presence of 12 regional lymph node metastases. Immunohistochemical study showed positivity for cytokeratins (AE1/AE3), cytokeratin 7, GCDFP-15, C-erbB-2, Mib-1, topoisomerase II alpha, p53, and androgen receptors. Diffuse positivity with chromogranin-A, synaptophysin, and Grimelius stains was also observed, suggesting endocrine features. Phosphotungstic acid hematoxylin, antimitochondrial antigen, progesterone and estrogen receptors, cytokeratin 20, and S-100 stains were negative. To our knowledge, this is the first case reported of SDC exhibiting neuroendocrine differentiation.

We report on a case of a patient with diagnosis of mycosis fungoides (MF) who subsequently developed enlargement of the intramammary lymph nodes, which were demonstrated to be involved by tumor on fine-needle aspiration (FNA) cytology. The patient was a 66-yr-old female who had recently noticed the appearance of circumscribed bilateral breast nodules. A mammographic study showed clearly outlined nodules of low density. FNA showed atypical small and large lymphocytes with cerebriform appearance, consistent with intramammary lymph node infiltration by MF. To our knowledge this is the first report of intramammary palpable lymph nodes involved by MF and confirmed by FNA. This case provides support for the use of fine-needle aspiration biopsy as an accurate method for staging MF successfully.

Thyroid adenomas containing adipose tissue are rare. Only scattered case reports have been recorded. We describe an additional case of an adenolipoma of the thyroid gland, incidentally found in residual gland subsequent to excision of a papillary carcinoma.